Provider Demographics
NPI:1144924747
Name:DORTCH, CHELSEA (LCSW, LSSW)
Entity type:Individual
Prefix:
First Name:CHELSEA
Middle Name:
Last Name:DORTCH
Suffix:
Gender:F
Credentials:LCSW, LSSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2475 DROIT RD
Mailing Address - Street 2:
Mailing Address - City:GALATIA
Mailing Address - State:IL
Mailing Address - Zip Code:62935-2476
Mailing Address - Country:US
Mailing Address - Phone:618-384-7066
Mailing Address - Fax:
Practice Address - Street 1:2475 DROIT RD
Practice Address - Street 2:
Practice Address - City:GALATIA
Practice Address - State:IL
Practice Address - Zip Code:62935-2476
Practice Address - Country:US
Practice Address - Phone:618-384-7066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-28
Last Update Date:2023-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1490253021041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical